IDEAS & TRENDS

IDEAS & TRENDS; ADVICE ON MAMOGRAMS IS USUALLY NOT TAKEN

By GINA KOLATA

Published: October 25, 1987

ABOUT two months ago, Dr. Leonard Davis, a radiologist in private practice in West Los Angeles, offered to do mammograms at the cut-rate price of $50 for women working at a Rockwell International plant in the San Fernando Valley. Dr. Davis, a strong advocate of mammography, the diagnostic technique that detected Nancy Reagan's breast cancer, reasoned that the price would be a strong incentive, since the test normally costs $100 to $150. Because it is a routine screening procedure, insurance ordinarily does not pay for mammography.

The company managers invited Dr. Davis to the plant, put a notice in the company newspaper and informed women employees that they could have the mammograms on company time. All they had to do was make an appointment.

Of 6,000 female employees at Rockwell, six called for appointments. Dr. Davis, dismayed, canceled the screening. ''I couldn't afford to do it for just six women,'' he said.

What happened at Rockwell reflects what is happening nationally, experts say. Only 10 to 15 percent of American women who should have had mammograms have ever had them, according to the American Cancer Society. The society suggests that all women have a mammogram between the ages of 35 and 40, that they have the test every few years between ages 40 and 50, and that they have annual mammograms after age 50.

The method, which uses very low doses of X-rays, can detect tumors before they can be felt and when treatment is most likely to be effective. Since one in 11 American women will get breast cancer in her lifetime, experts say all women should consider themselves at risk. According to Dr. Samuel Hellman of Memorial Sloan Kettering Cancer Center in New York, a Swedish study showed that women with no symptoms had 2 chances in 1,000 of dying of breast cancer within eight years if they had mammograms, and 3 chances in 1,000 if they did not.

Nancy Reagan ''was a perfect example'' of the value of regular mammograms, said Dr. Robert Wittes of the National Cancer Institute. Her 7-millimeter tumor was too small to be felt, and it was discovered so early that it was still confined to the milk duct where all breast cancers start.

Nancy Reagan's experience does appear to have inspired some women to seek mammograms. The American Cancer Society said it had a 75 percent increase this week in calls from women asking about mammograms. Radiologists said their business was up last week. At Community Radiologists in Silver Spring, Md., for example, about 40 women a day have been calling to schedule mammograms, whereas ordinarily only about 15 a day call. Dr. Davis said the same sort of increase occurred after Betty Ford had breast cancer in 1974 and that after about two months the torrent of calls died down to normal.

Experts say they are at a loss to understand why more women do not have the test, although they suggest several possibilities.

Even well-educated women who can well afford a mammogram put it off. Dr. Davis said some wealthy patients had told him they simply did not know about the test. He pointed out that breast cancer is a perennial topic in women's magazines and newspapers and said he assumes that women simply do not read the articles, perhaps because they do not want to know about this cancer. Reasons Not to Go

Some women said they put off the test because it did not seem particularly urgent and was time-consuming and expensive. Dalene Barry, a medical writer in Washington, said her gynecologist always suggests that she have a mammogram when she comes in for check-ups. Ms. Barry said she knows full well that she should have one, but she keeps putting it off. ''I guess I think I'm immune to breast cancer,'' she said.

''I said, 'Oh damn, I really ought to do it this year.' But I'm not going to do it this week because they'll be flooded with requests.''

Rose Kushner, executive director of the Breast Cancer Advisory Center in Kensington, Md., said having a mammogram, in addition to saving a life, might also save the breast. In light of Mrs. Reagan's decision to have her entire breast removed rather than just the tumor, Mrs. Kushner said she was concerned that many women would now put off mammograms out of fear that even if the test does detect an early cancer, the treatment still will be a mastectomy.

Mrs. Kushner told of a 42-year-old woman she has been counseling to get a mammogram. The woman is at very high risk for breast cancer because her mother died of the disease and her sister has already had cancers in both breasts and has had both breasts removed.

Recently, the woman agreed to have a mammogram. But she canceled her appointment when she heard about Mrs. Reagan. The woman told Mrs. Kushner that she saw no urgency if the treatment would be a mastectomy, no matter how small the tumor is. ''If I'm going to lose my breast, I may as well wait a few years longer,'' the woman said.

Photo of Nancy Reagan waving to supporters who greeted her at the White House after surgery (NYT/Jose R. Lopez)